Patella malalignment is a recognized cause of knee pain, tilt being one of its more common forms Although patellar tilt has been described both on the physical examination and on computerized imaging, to date the correlation between the two has not been established A strong correlation would strengthen the value of each Moreover, in situations where tilt cannot be clinically assessed (eg obesity), CT or MR imaging could be an adequate substitute for the clinical determination of tilt We propose to correlate the physical examination with the magnetic resonance examination by way of an MR Tilt Angle This angle is measured in a manner similar to the assessment of tilt on the physical examination, in that a line is drawn across the medial and lateral borders of the patella and referenced off the posterior femoral condyles Most tilt angles use the slope of the lateral facet as a measure of tilt These tilt angles paradoxically diminish as patellar tilt increases , a potential source of confusion In this study, we use an MRI tilt angle that increases in the same direction as the actual tilt, which is more intuitive We examined 30 patients with tilt and 51 patients without tilt Patients with significant tilt on the physical examination can be expected to have an MRI Tilt Angle that is 10 degrees or greater whereas an angle of less than 10 degrees is associated with the absence of significant tilt on the physical examination This MRI Tilt Angle fills the need for an easy, objective, intuitive measure of tilt and is an excellent adjunct to the physical examination

Patellar tilt: the physical examination correlates with MR imaging.

Patellar taping for the purpose of patellar medialization is a nonoperative rehabilitation technique used in the treatment of patellofemoral pain. Despite early reports of excellent success rates, the indications for this treatment and its efficacy on patellofemoral pain are unclear. The present computed tomography study was undertaken to evaluate the effect of patellar taping on patellofemoral incongruence. Sixteen female patients (age range, 16 to 25 years) with anterior knee pain related to patellofemoral incongruence underwent computed tomography examination with their quadriceps muscles relaxed and contracted both before and after patellar taping. Patellar lateralization was measured as lateral patellar displacement, and patellar tilt was measured as lateral patellar angle. Patellar taping did not significantly affect patellofemoral lateralization or tilt. The results of this study do not support the use of this method for passive correction of patellofemoral incongruence. Although patellar taping may well be effective in controlling anterior knee pain during physical therapy, it does not do so by medializing the patella.

The Effects of Patellar Taping on Patellofemoral Incongruence: A Computed Tomography Study

Anterior knee pain is a common complaint in the orthopaedic clinic. The differential diagnosis is wide and the principal goal of initial assessment is to detect remediable causes. The majority of patients do not have a specific disease and increasingly interest has focused on the role of patello-femoro-tibial morphology and of patellar maltracking in the aetiology of anterior knee pain. Classification in this group of patients is poor and there is no uniform agreement on which patient groups benefit from treatment and which treatment is best. Much of the literature involves relatively small numbers of patients, is poorly controlled and there is little agreement on outcome measures [1, 2]. The purpose of this review is to outline the current status of the imaging assessment of recalcitrant anterior knee pain with particular reference to patellar maltracking.

Imaging assessment of anterior knee pain and patellar maltracking.

BackgroundIt has been assumed that patellofemoral pain syndrome results from patellar malalignment. The precise role the vastus medialis obliquus plays in mediating the underlying pathologic abnormality is unclear.HypothesisThe morphologic characteristics of the vastus medialis obliquus correlate to patellar malalignment in patients with patellofemoral pain syndrome.Study DesignCross-sectional study; Level of evidence, 3.MethodsOne hundred twelve patients with patellofemoral pain syndrome were studied. Six sets of computed tomography axial images were assessed in which knee flexion was 0°, 15°, or 30° and the quadriceps muscle either relaxed or contracted. Measurements of serial cross-sectional areas of the vastus medialis obliquus and patellar malalignment were made. Correlation and stepwise regression models between the vastus medialis obliquus variables and patellar malalignment (lateral shift and patellar tilt) were calculated. Statistics were calculated on 4 subgroups depending on patellofemoral mala...

Role of the Vastus Medialis Obliquus in Repositioning the Patella A Dynamic Computed Tomography Study

At least seven parameters have been described for the measurement of patellofemoralmalalignment on CT scanning; three of which measure lateral patellar tilt, two lateral patellar shift and two femoral trochlear dysplasia. We studied 22 knees in 18 patients complaining of patellofemoral pain in order to investigate the reproducibility of these methods. CT scans of the patellofemoral joint were performed in each knee at 0° and 20° of flexion. The seven parameters were recorded from each scan by three independent observers in a blind study. The reproducibility was studied by means of the intraclass correlation coefficient (ICC). Parameters measuring lateral patellar tiltshowed excellent reliability (ICC>75%). The measurements of lateral patellar shift and femoral trochlear dysplasia showed a fair or poor correlation (ICC<75%). We suggest that parameters for measuring lateral patellar tilt only should be used from CT scanning when planning treatment for patello-femoral malalignment.

/pdf/reproducibility-of-patellofemoral-ct-scan-measurements-2ektvkwq11.pdf

Reproducibility of patellofemoral CT scan measurements.

A study of the patellofemoral joint in patients with patellofemoral pain has been carried out in 14 patients (18 knees) to compare CT scans with the knee extended fully and the quadriceps muscle contracted or relaxed. The purpose was to decide whether both examinations are necessary in young adults with suspected patellar malalignment. The patients were selected randomly. Thirteen knees were also examined in 20 degrees of flexion. The lateral patellar angle and the lateral patellar shift were measured. Linear regression analysis showed a proportional relationship between measurement with the quadriceps contracted and relaxed. Therefore, only one examination is needed and is easier to carry out in the relaxed state. Radiation to the patient and costs are reduced.

CT scanning of the patellofemoral joint. The quadriceps relaxed or contracted

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CT scanning of the patellofemoral joint. The quadriceps relaxed or contracted